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LAWMAKERS, AIDES LOOK FOR ACA EXEMPTION – How do you get top lawmakers to finally agree on Obamacare? When they talk about getting a pass from it, apparently. “Congressional leaders in both parties are engaged in high-level, confidential talks about exempting lawmakers and Capitol Hill aides from the insurance exchanges they are mandated to join as part of President Barack Obama’s health care overhaul, sources in both parties said,” POLITICO’s John Bresnahan and Jake Sherman report. Democrats and Republicans have been involved in sensitive talks over this for months, fully realizing they risk looking like huge hypocrites if they remove themselves from a major ACA component. One of the lawmakers’ biggest concerns is a feared “brain drain” if Hill staffers can’t get their exchange premiums subsidized by their employer — in this case, the federal government. OPM is reviewing several proposals, including one that exempts lawmakers and aides; another just exempts aides. The POLITICO story: http://politi.co/11FgLzF

HIGH-RISK POOL BILL PULLED … BUT WILL IT RETURN? — We probably haven’t seen the last of the Eric Cantor-backed bill boosting Obamacare’s high-risk pools, even after conservative lawmakers forced leaders to take it off the floor yesterday. A spokeswoman for the House majority leader said leaders “intend to bring the bill back up when the House returns in May,” blaming the delay on scheduling. Cantor had originally scheduled the vote before surveying members how they felt about shifting around Obamacare funds to provide another $4 billion for the law’s high-risk pools. It turns out conservative lawmakers aren’t big fans of the idea, and Democrats won’t support the bill because it takes money out of the ACA’s prevention fund. The POLITICO story: http://politi.co/13uwB1t

Happy Thursday and welcome to PULSE, where we’ve come up with a new drinking game. The rules are real simple. Sit in on a health care hearing and just wait for the words “train wreck.”

“So I took PULSE’s word for it at this time, I thought just havin’ a friend couldn’t be no crime”

HARKIN PLANS TO KEEP HOLD ON TAVENNER – Sen. Tom Harkin says he’ll keep his hold on Marilyn Tavenner’s nomination to lead CMS “until we get some things worked out” with the Obama administration. Those “things” would be the administration’s plans to take money out of the ACA’s prevention fund to support the federal-run exchanges. http://politi.co/ZJwqiA

McCONNELL: OBAMA NEEDS TO EXPLAIN ‘TRAIN WRECK’ – Yeah, that phrase again. Senate Minority Leader Mitch McConnell, in a Reuters op-ed last night, called on Obama to explain to the American people how terrible his health care law is. “When even a key architect of Obamacare says the law’s implementation will resemble a ‘train wreck,’ it is clear that its biggest remaining supporters need to finally level with the American people about what’s in store — starting with President Barack Obama,” McConnell wrote. McConnell even suggests that Obama hold a major address to explain to the public that “skyrocketing premiums and a raft of new taxes, penalties and fees are coming their way.” We’re sure Obama’s speechwriting team has been burning the midnight oil on that one. McConnell’s op-ed: http://reut.rs/ZlFieW

THE CO-OPS FIGHT ON – No, the ACA’s CO-OPS aren’t dead. There are just fewer of them than planned, but those behind the nation’s 24 Consumer Operated and Oriented Plans believe they’re going to catch on in a big way. It won’t be easy, though. The young CO-OPS, backed by billions in federal loans, will have to compete with large, established insurers hungry to scoop up new business on the insurance exchanges. Though this year’s fiscal cliff deal cut off funding for new CO-OPS, the ones in existence are eager to set up the nonprofit model and see opportunities for expansion. But health wonks question whether CO-OPs — seen as the consolation prize for liberals after the public option went down during ACA negotiations — can actually drum up enough business to have staying power. In addition to the challenge of competing with major insurers, CO-OPs are also under the watchful eye of GOP skeptics on the Hill, who say the CO-OPs are poised to become the next Solyndra. The POLITICO story: http://politi.co/14aMRc4

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WHITE HOUSE PICKS CAP VP FOR ACA COMMS – Center for American Progress Vice President Tara McGuinness has been hired in the West Wing to focus on communications and outreach around ACA implementation, an administration official told POLITICO’s Glenn Thrush. Her CAP bio: http://bit.ly/QrMWQs

WELLPOINT HAS BIG EXCHANGE PLANS – The nation’s second-largest health insurer said it’s planning to sell on exchanges in all 14 states where it currently operates — though it’s still waiting on some implementation details before totally committing, Reuters writes. WellPoint’s first-quarter earnings did better than Wall Street expectations, largely because of the company’s expansion of individual plans and Medicaid membership. The Reuters story: http://bit.ly/ZNgmtk

HAPPENING TODAY – The House Energy and Commerce Health Subcommittee holds a hearing on securing the nation’s prescription drug supply chain: http://1.usa.gov/XVuwgE. … HHS Secretary Kathleen Sebelius testifies on her department’s budget at the House Labor-HHS Appropriations subcommittee at 10 a.m. … The House Oversight and Government Reform subcommittee on health care and entitlements holds a hearing on consumer-driven market forces and transparency in health care: http://1.usa.gov/XVdL5a

HOUSE WATCHDOG QUESTIONS NAVIGATOR STANDARDS — Rep. Tim Murphy, who chairs the Energy and Commerce oversight subcommittee, wants to know whether community groups serving as exchange Navigators can accept donations from insurance companies — which seems like a possible conflict, since Navigators are there to help people understand their insurance options. Murphy put the question to CCIIO Director Gary Cohen during yesterday’s hearing on ACA implementation, but Cohen said he’ll have to look into it. Cohen noted, though, that Navigators are banned from accepting compensation for enrolling people in exchanges.

SLAUGHTER WANTS INFO FROM K STREET FIRM AFTER SUSPECTED MEDICARE ADVANTAGE LEAK — Rep.Louise Slaughter is asking the Greenberg Traurig law firm to disclose its relationships with political intelligence firms in light of its connection to a suspected leak of Medicare Advantage rates this month. “According to press reports, as a result of providing market-moving political intelligence information to Height Analytics LLC, Greenberg Traurig has lost Humana Inc. as a client, its relationship with Height Analytics LLC has been terminated and a preliminary investigation by the [SEC] is now underway,” Slaughter writes in a letter she’s sending to Greenberg Traurig today. “In light of those recent events, I request full disclosure of your lobbying organization’s relationships with political intelligence firms.” Sen. Chuck Grassley is also investigating Greenberg Traurig’s involvement in the suspected MA rate leak. A Grassley spokeswoman told POLITICO last night that Greenberg Traurig has turned over “some documents, but not a complete response.” Here’s Slaughter’s letter: http://politico.pro/17j8Hbx

STUDY: NEW BIRD FLU STILL MOSTLY POULTRY TO PERSON — Chinese scientists and public health officials can’t rule out limited human-to-human transmission of the deadly new H7N9 bird flu virus in China, according to findings published yesterday in the New England Journal of Medicine. But of 82 patients followed, transmission among humans may have happened in only two families, and researchers can’t confirm any such cases for sure. Public health officials around the world are keeping a wary eye out for signs that the virus has evolved so that it can be easily passed from person to person, which would be the precursor to a likely worldwide pandemic. But limited transmission among people has been seen in previous strains of bird flu and is not a major cause of concern, experts say. The Chinese investigators reported that three-quarters of the infected people had a history of exposure to chickens, which is evidence that the disease is primarily spread through poultry. But it’s still a nasty bug. About one in five infected have died and 60 remain critically ill, the paper reports. The median age of those infected is 63. The study: http://bit.ly/17XDETK

… The World Health Organization reports that H7N9 so far has sickened 108 people and killed 22: http://bit.ly/17O6ao0

WHAT WE’RE READING, by Kathryn Smith

The Georgetown Health Policy Institute’s Center on Health Insurance Reforms says the total estimated medical costs that will result from the Boston Marathon bombings could be as high as $9 million, and it looks at some of the expenses victims could face — even if they are insured. http://bit.ly/12JgyxU

At a meeting of the Committee on Veterans’ Affairs Wednesday, House Republicans wondered if the VA will be ready for an influx of new veterans signing up for health care when the ACA goes into effect, The Washington Times reports. http://bit.ly/10B8aCL

NPR looks at the trial of Philadelphia abortion provider Kermit Gosnell as it wraps up, and what those on both sides of the abortion debate agree on about it — as well as where they deeply disagree. http://n.pr/11CDRs6

The not-so-young invincibles: A new poll shows that as they age, the majority of Americans older than 40 aren’t preparing for a time in their life when they’ll require long-term care, the AP reports. http://apne.ws/10Blp6t

The FDA is beginning to test a device to identify counterfeit drugs for potential use in the United Sates, The Wall Street Journal notes. http://on.wsj.com/11CBlSH

The new head of the FDA’s Center for Tobacco Products promised that the agency will soon be taking action on marketing decisions for new products, Bloomberg writes. http://bloom.bg/17iKylb

** A message from PhRMA: PhRMA and America's biopharmaceutical research companies are committed to developing tomorrow's treatments and cures for a wide range of diseases, including leukemia, lymphoma and other blood cancers. New medicines are an integral part of the healthcare system, providing doctors and their patients with safe and effective treatment options that enable patients to live longer, healthier, more productive lives. **